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Our purpose in this article is to propose an overview of the specificities of therapeutic mediation through video games. We analyse the clinical implications of using a video game interface and its different functionalities. The use of the video game set-up involves requirements, like adjustment between the subject, the machine and the virtual environment. With the computer game interface, we are interested in the creation and use of an avatar. From a clinical case, we show how the avatar can be invested as an interface of communication